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Diversity in mental fatigue and social profile of patients with myasthenia gravis in two different Northern European countries
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology. Tartu Univ Hosp, Dept Neurol, Tartu, Estonia..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Tartu Univ Hosp, Dept Neurol, Tartu, Estonia..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
2017 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 7, no 4, article id e00653Article in journal (Refereed) Published
Abstract [en]

Tntroduction: Self-estimated health can be used for comparison of different diseases between countries. It is important to elaborate on whether disparities in self-estimated health are due to disease-specific parameters or socioeconomic differences. In this study, we aimed at evaluating clinical and social similarities and differences in myasthenia gravis (MG) patients between comparable regions in two Baltic Sea countries, Estonia and Sweden. Methods: This cross-sectional study included southern counties in Sweden and Estonia of comparable size. All patients with a confirmed MG diagnosis were asked to answer two questionnaires including demographic and disease-specific data, lifestyle issues, and mental fatigue (Fatigue Severity Scale [FSS]). Clinical fatigue was assessed objectively through the Quantitative Myasthenia Gravis Score (QMG). Results: Thirty-six of 92 identified patients in Estonia and 40 of 70 identified MG patients in Sweden chose to participate in the study. The demographic characteristics and symptoms reported by the patients were similar. QMG score did not differ; however, the Estonian patients scored their current subjective disease severity significantly higher (5.6 +/- 2.8) compared to the Swedish patients (3.4 +/- 2.3, p=.0005). Estonian patients also had significantly higher FSS scores (5.0 +/- 1.7) than Swedish patients (3.5 +/- 1.6; p=.001). Swedish patients were more active and performed physical activity more regularly (29.1% in Estonia and 74.2% in Sweden, p=.004). Conclusions: Although, the patients had comparable clinical fatigue, Estonian patients evaluated their health state as being more severe and reported more mental fatigue than Swedish patients. These data indicate large regional differences in disease perception of MG, which is important to consider in international studies.

Place, publisher, year, edition, pages
WILEY , 2017. Vol. 7, no 4, article id e00653
Keywords [en]
Estonia, fatigue, myasthenia gravis, Sweden
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-322219DOI: 10.1002/brb3.653ISI: 000399452500009PubMedID: 28413704OAI: oai:DiVA.org:uu-322219DiVA, id: diva2:1096394
Funder
Swedish Research Council, VR-523-2014-2048Available from: 2017-05-17 Created: 2017-05-17 Last updated: 2018-03-08Bibliographically approved
In thesis
1. Environmental Factors of Importance in Myasthenia Gravis: Emphasis on Physical Activity
Open this publication in new window or tab >>Environmental Factors of Importance in Myasthenia Gravis: Emphasis on Physical Activity
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Myasthenia Gravis (MG) is an autoimmune disease caused by antibodies directed against proteins at the neuromuscular junction (NMJ). The disturbed neuromuscular transmission induces fatigable weakness in skeletal muscles. The severity of MG ranges from purely ocular symptoms to extensive weakness with, at worst, respiratory failure and need of intensive care. Due to different pathogenic antibodies, as well as varying phenotypes there is a classification into MG subgroups.

As lifestyle disorders are common conditions they occur also in MG patients. It is unknown whether there are any lifestyle factors associated with MG or MG subgroups. However, medication side effects and disability due to disease could contribute to higher risks for lifestyle related diseases. General treatment guidelines are not suitable to MG patients, since various medications are known to affect the disease negatively and as the tolerance and effects of physical activity in MG is unknown.

In this thesis the occurrence of lifestyle related environmental factors in MG patients were investigated. MG epidemiology, subgroup differences and the presence of lifestyle related risks in MG patients were evaluated in Jönköping county in Southern Sweden. The findings were compared to a similar evaluation in a region of Estonia. We found that MG patients in the late-onset disease subgroup had a more disadvantageous pattern of life-style related risk factors, with a higher rate of obesity, smoking and physical inactivity and a lower rate of fish consumption in comparison to matched population controls. Furthermore, we found that despite comparable clinical muscle fatigue status, Estonian MG patients subjectively scored fatigue and disease severity higher than Swedish MG patients. More Estonian patients were physically inactive. The tolerance and effects of physical exercise was further evaluated in two intervention studies, where MG patients with stable disease performed a 12-week-training-program according to general exercise recommendations to healthy adults. We found that physical exercise was well tolerated by the MG patients and that they had a beneficial skeletal muscle response to physical exercise.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 75
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1439
Keywords
Myasthenia Gravis, MG subgroups, Environmental factors, Lifestyle, Physical activity, Exercise
National Category
Neurology
Research subject
Clinical Neurophysiology
Identifiers
urn:nbn:se:uu:diva-344667 (URN)978-91-513-0262-1 (ISBN)
Public defence
2018-04-27, Gunnesalen, Psykiatrins hus, Akademiska sjukhuset, ingång 10, Uppsala, 09:00 (English)
Opponent
Supervisors
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenSwedish Research Council
Note

Ytterligare forskningsfinansiärer: Neuroförbundet, Palle Ferbs minnesfond samt Erik, Karin och Gösta Selanders stiftelse

Available from: 2018-04-05 Created: 2018-03-08 Last updated: 2018-04-24

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